1. Field of the Invention
The invention relates to methods of treating periodontal disease.
2. Description of the Prior Art
The term "periodontal disease" actually encompasses a number of diseases that affect the supporting tissues of the teeth. The periodontium consists of the investing and supporting tissues of the tooth, and consists of the gingiva, the periodontal ligament, the cementum and the alveolar bone. The periodontium is subject to morphological and functional variations, to changes associated with age and to pathology.
The term gingivitis refers to an inflammation of the gingival tissue. Recent research on periodontal disease shows that not all patients with gingivitis progress to periodontal disease. However, gingivitis may be the first sign of oncoming periodontal disease and most, if not all, periodontal disease has an accompanying gingivitis.
Periodontitis is defined as inflammation involving the gingival unit (gingiva and alveolar mucosa) and extends to the periodontal ligament, alveolar bone, and cementum. Periodontitis involves loss of clinical attachment and radiographic loss of bone. The conversion clinically from gingivitis to periodontitis reflects the progression, histopathologically, from the established stage to the advanced stage of the periodontal lesion.
The vast body of evidence indicates that the primary cause of both gingivitis and periodontitis is bacterial activity. Bacteria attach to the tooth surface at and slightly under the gingival margin. They colonize and form an organized mass that is referred to as bacterial plaque. This plaque, if allowed to remain, brings about inflammatory changes in the tissues. The pathogenic potential of plaque can vary from one individual to another and from tooth to tooth within an individual. The reaction of the host tissues to this bacterial attack is through an inflammatory and immunologic defense mechanism.
Prophylactic measures to maintain good oral hygiene and keep teeth and gums in a relatively plaque-free state are important in the prevention of most treatable forms of periodontal disease. The patient's own brushing, flossing and utilization of certain antiseptic mouthwashes which may be of value in controlling plaque are supplemented by professional scaling and root planing treatments.
Once active periodontitis develops, however, a variety of treatment modalities have been utilized to combat the disease and prevent its progression. These include periodontal surgery: e.g., curettage, givgivectomy, flap or pocket elimination and the modified Widman flap procedure; and chemotherapy, particularly local and systemic antibiotic treatment. The antibiotic agents most frequently used are the tetracyclines and metronidazole. Excellent reviews of current knowledge regarding periodontal disease in general and periodontitis in particular, as well as conventional treatment methods, include V. J. Iacono, NYS Dent. J., 53:24-29 (1987); T. J. O'Leary et al., J. Periodont., 59:306-310 (1988); L. Saxen, Int. Dent. J., 35:291-296 (1985); W. C. Hurt et al., Baylor Dent. J., 32:17-19 (1988).
The conventional methods currently utilized to treat periodontal disease suffer from a number of significant drawbacks. Surgical reduction of periodontal pockets can expose roots, cause sensitivity, and result in poor esthetics by a lengthening of the clinical crown and altering the gingival contours. Surgical treatment does not guarantee that the disease process will not recur to the detriment of the patient's dentition.
Antibiotic therapy is not usually totally successful, particularly in advanced cases, probably because the site of action of periodontal disease is not accessible to a sufficient concentration of drug at the base of the periodontal pocket to completely halt the disease process. Anti-microbial solutions have been introduced through irrigating devices to the periodontal pocket with some success, but are not curative. Sustained systemic administration of antibiotics such as tetracyclines is inadvisable because of the potentially serious side effects and the possibility of giving rise to antibiotic-resistant infections.
New, more effective approaches to the treatment of periodontal disease, particularly periodontitis, are actively being sought.